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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A descriptive study of 615 girls 10-19 years of age attending their first prenatal visit at 2 rural hospitals in southern Malawi revealed a need to improve the quality of antenatal care for this high-risk group. 52% of teens were nulliparous and 73.3% were illiterate. Most nulliparae first attended for antenatal care at 20-23 weeks of gestation, while multiparae tended to report at 24-27 weeks. The mean number of antenatal visits was high: 5.3. 26.6% of pregnant adolescents were HIV-infected, 34.4% had malaria, and 92.6% were anemic. Details of pregnancy outcome were available only for the 251 girls (41.5%) who presented for supervised delivery. Girls who were nulliparous, illiterate, made early antenatal care visits, or gave a history of stillbirth or abortion were less likely to attend for delivery. 40% of primiparae under 17 years of age and 28.3% of multiparae had a low-birth-weight infant. Logistic regression analysis indicated that low birth weight was significantly inversely associated with literacy and number of antenatal care visits. The prevalence of peripheral parasitemia was as high at delivery as at first antenatal visit, indicating that malaria control during pregnancy was not performed or was not effective. These findings indicate that, when adolescent pregnancy begins at an early age, girls in their first and second pregnancies require intensive monitoring. On the other hand, in settings such as Malawi, where many young girls are anemic and HIV-infected when they become pregnant and have infections such as schistosomiasis that cannot be treated during pregnancy, programs must be initiated to improve the health status and literacy of young girls before they reach childbearing age.
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PMID:Improving antenatal care for pregnant adolescents in southern Malawi. 959 48

Pregnant women with Plasmodium falciparum infection are at increased risk for complications such as anemia and cerebral malaria. In addition, the infants of these women suffer intrauterine growth retardation (IUGR), low birth weight (LBW), congenital infection, and high infant mortality. Although much has been learned from studies of malaria during human pregnancy, progress has been limited by the lack of a suitable animal model. Nonhuman primates are of particular interest because, other than the armadillo, they are the only animals with a discoidal, villous, hemochorial placenta like that of humans. We have established a model of malaria during human pregnancy by inoculating pregnant rhesus monkeys (Macaca mulatta) with Plasmodium coatneyi (a sequestering parasite) during the first trimester. In our initial experiment, four monkeys were inoculated with a fresh inoculum containing 10(8) viable parasites from an infected donor monkey. All four monkeys became parasitemic seven days postinoculation (PI) and three monkeys aborted 7-10 days PI coincident with high peak parasitemias (41,088-374,325 parasites/mm3). Although abortion is one of the outcomes observed in Plasmodium-infected women, the intent of this study was to examine the effects of Plasmodium infection throughout gestation. Since the rapid onset of high parasitemia may have been responsible for the abortions, a decision was made to reduce the size of the effective inoculum. Six additional pregnant monkeys were inoculated with a frozen isolate taken from the same donor containing 10(6) parasites. These six animals became parasitemic by 14 days PI and, along with monkey E412, carried their infants to term. These seven infants weighed significantly less at term than the infants of uninfected mothers (P = 0.0355). Symmetrical IUGR was detected by ultrasound in one fetus with an LBW of 334 g. Another LBW infant (300 g) had asymmetrical growth retardation, which has been associated with uteroplacental insufficiency and was consistent with the lower placental weights found in infected dams compared with controls (P = 0.0455). The infant with symmetric IUGR died at five days of age, while the other is alive but congenitally infected. The IUGR, LBW, congenital infection, postnatal infant mortality, and early abortions observed in these animals suggest that P. coatneyi in pregnant rhesus monkeys is a valid model of malaria in human pregnancy. This model should provide the opportunity to study questions about malaria in pregnancy that have been difficult to study in humans.
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PMID:Plasmodium coatneyi in the rhesus monkey (Macaca mulatta) as a model of malaria in pregnancy. 971 32

Economic deterioration and a decade of military rule have had a disastrous impact on the health of women and children in Burma. In 1996, Burma's infant mortality rate was 105/1000 live births. The major causes of child mortality and morbidity are intestinal and respiratory infections, malaria, malnutrition, and vaccine-preventable diseases. Low birth weight, iodine and vitamin A deficiency diseases, and iron-deficiency anemia are widespread. Cholera outbreaks occur each year. The Universal Child Immunization Program, supported by UNICEF, reaches less than 60% of eligible children. The maternal mortality rate is 580/100,000 live births; most are related to unsafe abortion. Basic reproductive health care is available only in select areas of the country. 17-22% of women use modern contraception. UNAIDS has estimated that 440,000 Burmese are HIV-infected and there are 14,000 AIDS orphans. HIV prevalence is 26.5% in urban prostitutes, 91% among injecting drug users near the Chinese border, and 10.6% among pregnant women in one border town. Any improvement in the health status of the population requires a shift in priority on the part of the military government from weapons build-up to health promotion and protection.
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PMID:Burma: a country's health in crisis. 977 77

In tribal villages of central India where malaria is highly prevalent (mesoendemic), this preliminary study was undertaken to determine the effects of malaria infection in a group of 456 pregnant women with or without fever. Only 96 women were found infected with malaria, of which Plasmodium falciparum accounted for 64% of the detected parasites, while P. vivax for the remaining 36%. There were no instances of cerebral malaria or death however, one abortion and four still births were recorded among 38 primigravid women. Only one neonate was found infected with P. falciparum on day 21 though parasitemia was not high. Anemia was commonly present in most of the women (80%). Failure to clear P. falciparum parasitemia after a chloroquine regimen (25 mg/kg of body weight) was commonly observed. Persistent P. falciparum parasitemia was recorded in 8% cases. Poor response to chloroquine suggests the need to change the drug policy.
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PMID:Studies on malaria during pregnancy in a tribal area of central India (Madhya Pradesh). 974 Feb 60

In experiments carried out in mice, hamsters, guinea pigs and rabbits both dihydroartemisinin and artesunate showed contragestational effect. In mice and rabbits they caused embryo absorption whereas in hamsters and guinea pigs they induced abortion. The contragestational ED50 of dihydroartemisinin given sc on d 7 of pregnancy in mice and d 5 of pregnancy in hamsters were 32.8(27.7-38.9) mg.kg-1 and 6.1(5.6-6.7) mg.kg-1 respectively. The ED50 of this drug given im on d 18 of pregnancy in guinea pigs was 18.3(13.9-24.2) mg.kg-1. Dihydroartemisinin also showed mid-pregnancy terminating effect in hamsters. The contragestational ED50 of artesunate given sc on d 5 of pregnancy in hamsters and the ED50 of sodium artesunate given sc on d 5-8 of pregnancy in hamsters were 12.2(10.3-14.4) mg.kg-1 and 1.0(0.9-1.2) mg.kg-1 daily respectively. Results of light microscopic examination revealed that dihydroartemisinin was selectively toxic to embryo sac. At dose levels sufficient to induce embryo sac necrosis, dihydroartemisinin did not injure the uterus and ovary of the maternal animals. On the ground of the foregoing observations we consider that dihydroartemisinin, artesunate and their analogous drugs should not be used to treat malaria in pregnant women and there is the possibility to exploit intentional abortion agents from artemisinin derivatives.
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PMID:[Contragestational effects of dihydroartemisinin and artesunate]. 986 30

An anthropological examination is made of the Esan population living in Ekpoma, Egoro-Haoko, OkhuEsan, and Ubiaja in Edo State, Nigeria, during 1988-89. The focus is on the Esan perception of illness, the Esan health behavior, and the treatment of illness. The sample areas are not densely populated due to migration to urban areas. Traditional or Christian religions are practiced. Piped water, good roads, and electricity are inadequate. Polygyny is widely practiced. The Esan people believe illness is caused by people or natural or supernatural forces. The most common illnesses among children are measles, convulsions, and headache, which are attributed to supernatural factors. Diarrhea, vomiting, malaria, smallpox, chicken pox, pneumonia, and tetanus are thought to be due to natural factors. Child mortality due to witchcraft is reduced through the taking of oaths at shrines. Christianity has helped to protect people from the power of witches and wizards. In traditional times, natural illnesses were attributed to poor sanitation, poor nutrition, and lack of good water. Presently, women believe that natural illnesses occur from environmental factors such as overgrown weeds or poor water drainage. Many health programs have improved the situation for prevention and treatment. Adult male illnesses are reported as back and waist pains, sugar disease, hemorrhoids, blindness, and sudden swelling of the body, legs, and knees. Blindness occurs due to supernatural forces caused by a lack of maintaining traditional customs, such as adultery of a wife. When a husband dies of a supernatural illness, the wife is frequently held accountable. Adult females report illnesses from pregnancy, childbirth, and postpartum. Miscarriage, hemorrhage, retention of the placenta, and obstructed labor are considered to be due to supernatural factors subsequent to such behaviors as having sex in the afternoon or in the fields. Traditional treatment is dispensed according to the type of illness and is mainly used by adults. Children are treated more quickly than adults. Cost and distance from health services affects use of modern medicine. Mixes of modern and traditional practices are common.
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PMID:The socio-cultural context of health behaviour among Esan communities, Edo State, Nigeria. 1014 69

The study aimed to analyze reasons for the use or non-use of antenatal care services and malaria treatment among pregnant women living in rural areas in Uganda. Focus group discussions with pregnant women, in-depth interviews with key informants (Traditional Birth Attendants (TBAs) and health workers) and a structured questionnaire administered to pregnant women were used to collect the relevant information. Antenatal care attendance was irregular and few women knew that the purpose of attending antenatal care was to monitor both the growth of the baby and the health status of the woman. Parity significantly influenced antenatal care attendance, but level of education, religion and marital status did not. Fifty-five per cent of the women stated that they had delivered outside the formal health delivery system despite antenatal care attendance. All women in their second pregnancy had delivered their first child in the village, despite TBA training to the contrary. Malaria as perceived by pregnant women is common and multiple health service providers are used for its treatment. About 66% of the mothers reported having suffered from malaria during the current pregnancy; of these more than half had received treatment outside the formal health delivery system. Self-treatment with drugs bought from ordinary shops was commonly reported. Nearly all women (93.3%) knew about the antimalarial drug chloroquine and 83% thought that it was used for the treatment of malaria, not for its prevention. Some women believed that the drug could cause abortion. Health seeking behaviour was influenced by several factors, including the perceived high cost of antenatal care services, of conducting a delivery and treatment, and perceived inadequacy of services provided by the formal health system. Inadequacy of formal health services was perceived by users to be partly due to understaffing and to irregular supply of essential drugs. Intensive health education to pregnant women on the safety of chloroquine use in pregnancy, the importance and the need for regular antenatal care attendance are recommended. In addition, training of more TBAs and continued educational efforts to upgrade their knowledge, regular and adequate supply of essential drugs, and free health services for high-risk groups such as pregnant women are recommended to improve antenatal care services and drug prophylaxis use in pregnancy.
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PMID:The use of formal and informal services for antenatal care and malaria treatment in rural Uganda. 1017 89

This article presents the results of a study on the effects of Plasmodium vivax infection during pregnancy. Pregnant Karen women living in open camps to the north and south of Thailand were the subjects of the study. In each camp, the subjects attended weekly antenatal clinics for physical examination and blood screening by microscopy for malaria parasites; the outcome was recorded. The investigators compared the effects of P. vivax infection on anemia and pregnancy outcome women with those of P. falciparum and no malaria infection in the first pregnancy recorded at the clinics. Results showed that P. vivax malaria was more common in primigravidas than in multigravidas and was associated with mild maternal anemia and significantly decreased birth weight by comparison with babies born to women with no evidence of malaria during pregnancy. By contrast with P. falciparum malaria, the decrease in birth weight was greater in multigravidas. The mean birth weight was 107 g lower in women with P. vivax infection than in uninfected women. Infection with P. vivax during pregnancy was not associated with shorter gestation or with an increased rate of miscarriage or stillbirth. The findings suggest that studies of P. vivax, P. malariae, and P. ovale malaria in pregnancy should be encouraged and that chemoprophylaxis against P. vivax malaria in pregnancy may be justified.
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PMID:Effects of Plasmodium vivax malaria in pregnancy. 1047 Jun 98

Falciparum malaria in pregnancy is a significant health problem in India. Pregnant women constitute an important high risk group for malaria infection which may cause abortion, still births, intra uterine growth retardation (IUGR), and pre-mature labour. Two hundred eighty-eight admitted female patients of falciparum malaria were included in the study out of which 45 were pregnant. The mortality rate was highly significant in pregnant females (37.77%) in comparison to non-pregnant females (14.81%); (p < 0.001). The incidence of various pernicious syndromes including cerebral malaria, severe anaemia (Hb < 5 g%) hepatic and renal failure were more in pregnant females in comparison to non-pregnant females. The incidence of infection was higher among primigravida and second gravida 30/45 (66.66%) as compared to multigravida 15/45 (33.33%) and the greater incidence of infection was seen during 14-28 wk of gestation 23/45 (51.11%). Pregnancy related complications in the form of preterm live birth (20%). Intra uterine death (IUD 31.11%), still births (13.33%) and abortions (11.11%) were more pronounced in primiparous women as compared to multiparous. Weight of placenta in majority of patients ranged between 200-400 g (22/31; 70.96%). Normal pregnancy continued in only 11 out of 45 pregnant females, out of which seven had low birth weight body (63.63%). As the pregnancy is associated with increased incidence and adverse outcome of falciparum malaria infection, chemoprophylaxis should be made an integral part of antenatal care along with antianaemic therapy to reduce the risk of serious maternal and fetal complications.
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PMID:Falciparum malaria and pregnancy. 1049 38

According to the World Health Organization, 585,000 women die each year from a pregnancy-related cause, 99% of whom are from developing countries. The first International Conference on Safe Motherhood in 1987 sensitized the world community to this drama. Ever since, maternal mortality and its medical causes are better known. The maternal mortality ratio is highest in West Africa (1,020 maternal deaths per 100,000 live borns) when it is 27/100,000 in industrialized countries. Direct obstetric causes account for 80% of the deaths: hemorrhage, infection, dystocia, hypertension and abortion. Indirect causes are essentially anemia, malaria, hepatitis C and AIDS. Severe maternal morbidity is 6 to 10 times more frequent than maternal mortality but it also leads to handicaps which end up often in women's social rejection. However, WHO estimates that 95% of these deaths and handicaps are avoidable, and at a low cost.
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PMID:[Pregnancy and delivery in western Africa. High risk motherhood]. 1050 33


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